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Self-Prescription of Antibiotics Boosts Superbugs Epidemic in Europe

Antibiotics kill bacteria, not viruses. Viruses, which antibiotics do not affect, cause 9 out of 10 sore throats and 10 out of 10 cases of influenza. Taking antibiotics unnecessarily weakens their ability to work against infections when they are needed. This enables bacteria develop resistance to antibiotics. On European Antibiotic Awareness Day 2012 (Nov. 18, 2012), the World Health Organization (WHO) advises the public to use antibiotics only when and as prescribed by a doctor.

“Since their discovery over 70 years ago, antibiotics have kept most of us alive by overcoming bacterial infections that could otherwise have been fatal. The use of antibiotics – and vaccines – has lengthened our life-spans by 20 years on average,” says Zsuzsanna Jakab, WHO regional director for Europe. “If we want to retain this medical miracle, we must fully understand when antibiotics work and do not work, and act accordingly. This is a matter for everybody, from those who set policies and strategies, carry out research, and produce and distribute antibiotics to those who prescribe and use them.”

Awareness of the effects of overusing and misusing antibiotics is higher globally but lower in countries where antibiotics are less regulated and can be obtained over the counter, without prescription: in 2 out of 3 countries in the eastern part of the WHO European Region. A global WHO survey indicated that over half of all medicines – including antibiotics – are prescribed, dispensed or sold inappropriately, while half of all patients fail to take medicines correctly. This leads to increased antibiotic resistance and thereby decreases the number of effective antibiotics. In addition, it is alarming that no new antibiotic classes have been discovered in the last 25 years, despite the efforts of research.

The problem has not only enormous health consequences but also large economic effects for both individuals and societies, as resistant infections can be up to 100 times more costly to treat. Incurable or hard-to-treat infections are already found in the European Region. Every year, over 80 000 people develop tuberculosis that is resistant to antibiotics. Some developed European countries recently reported cases of cephalosporin-resistant gonorrhoea, which is extremely difficult to treat.

In this area, one of today’s main threats to Europe is the spread of bacteria that are increasingly resistant to antibiotics of the carbapenems family. These antibiotics are the only available cure for serious diseases such as those from multidrug-resistant Escherichia coli bacteria. Virulent strains of E. coli can cause gastroenteritis, urinary-tract infections and more severe conditions, such as meningitis, haemolytic-uraemic syndrome, septicaemia and pneumonia. In the last two years, resistance to carbapenems has surfaced in several European Union (EU) countries, jeopardizing the ability to treat patients. The easy transmission of carbapenem-resistant bacteria between patients and the increasing introduction of these bacteria into Europe from countries where they are widespread worsen the situation.

Mapping antibiotic use and resistance is a key aspect of the European strategic action plan on antibiotic resistance, endorsed by all WHO member states in Europe in 2011. On Oct. 30, 2012, WHO/Europe signed an agreement with the National Institute for Public Health and the Environment (RIVM) of the Netherlands and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) to survey, contain and prevent emergence and spread of antibiotic resistance in countries that are in the Region but outside the EU. This complements surveillance conducted in EU countries by the European Centre for Disease Prevention and Control (ECDC) through the European Antimicrobial Resistance Surveillance Network (EARS-Net). A harmonized and coordinated surveillance network in all countries in the European Region is key to protect health from a cross-border threat.

ECDC has coordinated European Antibiotic Awareness Day since 2008. This year, WHO has joined forces with ECDC to extend the event to all 53 member states in the European region. For the first time, eastern European and central Asian countries are joining EU countries in activities that promote the prudent use of antibiotics. WHO/Europe and ECDC will host a joint Twitter session, with the support of the European Commission, on Nov. 20, 2012.